Provider Demographics
NPI:1750922712
Name:GIGUERE, PATRICK RYAN (LMT)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:RYAN
Last Name:GIGUERE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 WILSON AVE APT B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1449
Mailing Address - Country:US
Mailing Address - Phone:614-483-9601
Mailing Address - Fax:
Practice Address - Street 1:1196 NEIL AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-3120
Practice Address - Country:US
Practice Address - Phone:614-483-9601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.024165225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist